Ultrasounds for prehospital recognition of tension pneumothorax

摘要

We read with great interest the article of Cantwell et al. [1], assessing an improvement in the prehospital recognition of potential tension pneumothorax in the setting of traumatic chest injury. The authors have emphasised a change in education and clinical practice increase the number of patients receiving needle decompression for a tension pneumothorax in prehospital care.In the era of ultrasonography, thoracic ultrasound (US) was determined as a valuable diagnostic method of pneumothorax in multiple studies. Already in 2001, Dulchavsky et al. [2], diagnosed 37 of 39 pneumothorax with US, 382 trauma patients, with a sensitivity of 94%. Later in 2004, Knudtson et al. reported that US was a reliable test in the diagnosis of pneumothorax with 99.7% specificity, assessing that US were an important adjuvant role to clinical investigation in penetrating trauma [3].In a study of 204 trauma casualties by Nandipati et al. thoracic US appeared as a simple method and had a higher sensitivity compared to the chest X-ray and clinical examination in detecting pneumothorax (95% vs 79% and 95% respectively) [4]. Further its high sensitivity, thoracic US offer several advantages [5]: high feasibility (the lung can almost always be visualised), rapidity (a critical advantage in extreme emergencies), short learning curve (correctly trained physicians quickly master the signs), absence of radiation, real-time imaging, ability to easily perform dynamic and repeat evaluations at the bedside (without unnecessary delay for patient transport in unstable situations). Thoracic US, easily performed at the bedside in the trauma room, are now incorporated into Advanced Trauma Life Support (ATLS) guidelines as focused assessment with sonography for trauma (FAST)